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HomeMy WebLinkAboutBuilding Permit #273 - 58 FERNWOOD STREET 10/6/2006 L TOWN OF NORTH ANDOVER NpRT11 APPLICATION FOR PLAN EXAMINATION o� L O Permit NO: Date Received Date Issued: V W G �9SSACHus���y IMPORTANT: Applicantmusts complete all items on this page LOCATION 8 �er-�c�wOd (PIZ& Print PROPERTY OWNER �e-AALJ kildt- Print MAP NO.: PARCEL: ZONING DISTRICT: TYPE AND USE OF BUILDING HISTORIC DISTRICT YES ❑ TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑New Building gel One family E Addition ❑Two or more family Industrial Alteration No. of units: ,?'Repair, replacement ❑ Assessory Bldg ❑Commercial Demolition I Moving(relocation) ❑ Other Others: C Foundation only DESCRIPTION OF WORK TO BE PREFORMED LS ri Identification Please Type or Print Clearly) �.inoo/ — �y fe Phone: g�S �'•t3 y OWNER: Name: � r 1 Address: k Jrg 4L DD I h fo 0�'cJ YOU CONTRACTOR Name: of l!J L. , 11 Phone: sv tin su 22 o 4V4 l jj& /Y� d l �� Address: 2� Supervisor's Construction License: Exp. Date: Home Improvement License: /O S�+�lo Exp. Date: ARCHITECT/ENGINEER Name: Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED CAST BASED ON$125.00 PER S.F. Total Project Cost :$ // !o0 o• 0 u FEE:$ Check No.: Receipt No.:__� Page Iof4 T_ - r Location `�• ��-ti-.s«.a-n- - No. 7 Date TOWN OF NORTH ANDOVER I F? °. • p9 + ; . Certificate of Occupancy $ '',s°�nO•E<�' Building/Frame Permit Fee $ sCHUS Foundation Permit Fee $ Other Permit Fee $ TOTAL $ L Check # 19664 //' Building Invpector I TYPE OF SEWERAGE DISPOSAL Swimming Pools ^i Tanning/Massage/Body Art L o Public Sewer .__ _ `-.-I Tobacco Sales Food Packaging/Sales Well Permanent Dumpster on Site Private(septic tank, etc. L ! Electric Meter location to project NOTE: Persons contracting with unregistered contractors do not have access to the guaranty.fund Signature of Agent/Owner Signature of contractor C � Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF- U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ ❑Water Shed Special Permit ❑ Site Plan Special Permit ❑ Other COMMENTS DATE REJECTED DATE APPROVED CONSERVATION ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED HEALTH ❑ ❑ COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water& Sewer connection/Signature& Date Driveway Pennit Temp Dumpster on site yes_no_ Fire Department signature/date Building Setback (ft.) Front Yard Side Yard Rear Yard Required Provided Required Provides Re aired Provided Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. s Total land area,sq. ft.: NOTES and DATA—(For department use) Parc 3 of'4 Doc:INSPECTIONAL SERVICES DEPARTMENT:B13FORM05 Created JNIC.Jan'006 r Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits ❑ Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior Work Addition Or Decks ❑ Building Permit Application ❑ Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) New Construction (Single and Two Family) ❑ Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract u Mass check Energy Compliance Report In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc:INSPH r111NAL SERVICES DF-PAR'JAIF.NT:1311FORN105 I . .._._�. — _.._..... NORTH Town o �` Andover 0 No. - 3 h D ob L' LAKE over, Mass.,Mass., • I� COCHICHEWICK 7�ADRATED C7 `s BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT.................... ....110A011.... goo... .................................... .............. . ""' ' Foundation has permission to erect........................................ buildings on..�......... .................................Q.. ....... Rough to be occupied as............1-e ,- ...... .......... .............. chimney provided that the person accepting this permit shall in eve respect conform to the terms of the lication on file in Final this office, and to the provisions of the Codes and By-La relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6ZT7HSUNLESS CONSTRUCELECTRICAL INSPECTOR Rough ............... .. ........................................................................ Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. The Commonwealth of Massachusetts ' Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): o D6, Address: 200 S(An &iy&A • Sutt. 224 City/State/Zip: tag i' UdVefIM Phone #: Are you an employer?Check a appropriate box: Type of project(required): l�I am a employer with 4. 0 I am a general contractor and I 6, 0 New construction employee's(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. I ❑ Remodeling ship and have no employees These sub-contractors have 8. 0 Demolition working for me in any capacity. workers' comp. insurance. 9. El Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.El Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions myself. [No workers' comp. C. 152, §1(4),and we have no 12.❑ Roof repairs insurance required.] t employees. [No workers' (� 13.El Other comp. insurance required.] *Any applicant that checks box#]must also fill out the section below showing their workers'compensation policy information: t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such tConvactors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp,policy inforTnation. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic. #: VW Expiration Date:__ Job Site Address:--,59 r (1lLl do( J}rtL'4 City/State/Zip:— uik AQ,&i o c� Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year'imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct: Signature: C c c [ Date: Phone#: (Q 7 Oficial use only. Don write in this area,to be completed by city or town officiat City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#• Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as "an individual,partnership, association, corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer,or the l; receiver or trustee of an individual,partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s), address(es)and phone number(s)along with their certificate(s) of insurance. Limited Liability Companies (LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the pernut or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number-listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure.that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job'Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, lease do not hesitate to give us a call. P gl The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. #617-727-4900 ext 406 or 1-877-MASSAFE Revised 5-26-05 Fax#617-727-7749 www.mass.gov/dia Town of North Andover o� tkoR��, ��S4iE0 /6 •� i. Building Department o 27 Charles Street North Andover, Massachusetts 01845 4 1 (978) 688-9545 Fax (978) 688-9542 cHust. DEBRIS DISPOSAL FORM In accordance with the provisions of MGL c 40 s 54, and a condition of. Building permit# the debris resulting from the work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL cl 1, s150a. The debris will be disposed of in/at: Nd Facility location 1 Signature of Applicant Date NOTE: A demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector. X12104 DAVID CASTRICONE CASTRICONE ROOFING&SIDING INC. ROOFING,SIDING&REMODELING REPLACEMENT WINDOWS HOME IMPROVEMENT CONTRACTOR REGISTRATION NUMBER 104569 200 SUTTON STREET,SUITE 226,NO.ANDOVER,MA 01845 In North Andover 978-683-3420 In Boxford 978-887-6147 In HaverhiM 978-374-7314 Uwe the owner(s)of the premises mentioned below,hereby contract with and authorize you as contractor,to furnish all necessary materials,labor and workmanship,to install,construct and place the improvements according to the following specifications,terms and conditions,on premises below descri r Owner's Name...... „��17,a1 .. . 1 a. ....(....0. &...................................Te hone#...•F.L{ :....�.�.c3..p....... Job Address....v.. ...... Nr►.w4. . . .....s..l.d..r......................City.... '..............State.... Specifications: .............. Areas to be covered: l �p. ... .........:� ...`.`.....q.� ° ws ............................... apply vinyl siding and corners. Type: /'jFs..Vlt`� J war "Cover fascia boards and rake boards. wflistall vinyl soffit solid .............................................................�....................................�.........................ry.....................................,................................... Utove�wood casings around wi ow A, � lace am bl v nts and d ejj V nts with vinyl. .�.sKa.o1 a.�...1'... J.R.Ar............... .............................. ....................1.. .................................................................. 14(pply underlaymeIL T C1---M r'60 W xx ....................... ... ... ................. ............................................... ........................................................................................... �E:Lcting siding ripped go-over -C6a-1 disposal of a0 debris. p.........®..f............................ ,...G�.............................................................................................................\.................. 'Ito"t%ted wood rL(eynlaced GO /sheet or ", /foot` - ..F'6.� .. .....i.�.. e1.1. ..... T.Y..a...l v.t:Sr.1:w—e.....�a.11 fA-/./..&.1-.. q.......1�►CR ................. [.............. ......c ..:........... G........4........... . . ..... ........ ............ a. . /i .YJ... r . t ) p� Warranty y The cgalractor agrees to perform the w(orktart sfur sh the � s�s� fled above the SU of Sb...1�.Z 0 actu r (J j� j/ J .......... Payable.......�o�...............on....5.. Payable.........—..............on.............=.............-(9B alance payable on completion of job Owner or Owners are not responsible for Property Damage or Liability while job is in operation. Contractor is not responsible for any damage to the interior of property,including pro existing conditions(i.e.wale stains,crumbling plaster,eposod trails)or conditions resulting fmm application of materials specified above(i.e.objects coming loose from walls,crumbling plaster,exposed nails,dust in attic or other living spaces).Upon completion of above work,all undersigned agree to execute and deliver to contractor,thein joint note in accordance with his(their)above obligation as requested by contractor. Upon refusal to do so,contractor may at its option declare the entire contract price or so much as their remains unpaid,immediately due and Payable. It is agreed that,if permitted by law,contractor shall be paid by the owner(s)all reasonable costs,attorney fees and expenses,m addition to the amount due and unpaid,that shall be incurred in enforcing the terns and conditions of the contract and/or any liar in connection herewth.It is further athat this co maY be assigned by contractor,and also that the obligations hereof shall bind and apply to their heirs,successors or econtract states i the pangreed parties.The undersigned w ntracts) that he is(they ere)the owtnas(s)of the above mentioned premises and Wert legal title thereto stands of record in his(their)names(s).These are no representations, ties or warranties,except such as may be herein incorporated,if any,nor any agrOwmts collateral hereto,nor is the contract dependent upon or subject to any conditions not herein stated.Any subsequent agreement in reference hereto shall be binding only if in writing and signed by all parties. All Home Improvement Contractors shall be registered and any inquiries about a contractor or subcontractor relating to a registration should be directed to:Director,Home improvement Contractor Registration, One Ashburton Place, Room 1301,Boston,MA 02108 Tel:617-727-8598 Any and all necessary construction-related permits shall be obtained by the Contractor. Any Owner who secures his own construction_ related permit or deals with unregistered contractors is excluded from the Guaranty Fund provisions of MGL c.142A Approximate starting date of work................................................ Completion date...................... .......... ...... ................... Receipt of a copy of this contact is hereby acknowledged,and it is further acknowledged by the undersigned that the foregoing . provisions have been read and the contents thereof understood and that no representation or agreement not herein contained shall be binding upon the parties and that all of the agreements and understandings of said parties are contained herein. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES Owner has three business days to cancel this contract and incur no penalty (see noti f cancellati IN WITNESS WHEREOF,the parties have hereunto signed the' s this. // �!. ...day of.16 ,20...�.�i Accepted: Sign ............ ........ ............................................ Owner Signed.».»..................................................................... Owner ... . . . David Castricone,President/) Town of North Andover OORTH Building Department o 27 Charles Street North Andover, Massachusetts 01845 , ®ti (978) 688-9545 Fax(978) 688-9542 A0 AUS `s DEBRIS DISPOSAL FORM In accordance with the provisions of MGL c 40 s 54, and a condition of. Building permit# the debris resulting from the work shall be disposed of in a properly licensed solid waste the facility as defined by MGL cl 1, s15Oa. The debris will be disposed of in/at: �.� s' o Facility location DIIJ Signature of Applicant Date NOTE: A demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector.